Medical Marijuana in Ohio

DIRECTIONS & CRITERIA FOR SUCCESSFUL COMPLETION

1.   Please read carefully the below article “Medical Marijuana in Ohio.”

2.   Complete and submit the post-test, evaluation form and the registration form.

The post-test will be reviewed. If a score of 70 percent or better is achieved, a certificate will be emailed to you and contact hours will be awarded. If a score of 70 percent is not achieved, a letter of notification of the final score and instructions on how to take second post-test will be sent to you. We recommend that this independent study be reviewed prior to taking the second post-test. If a score of 70 percent is achieved on the second post-test, a certificate will be issued.

If you have any questions, please contact the Ohio Nurses Association’s CE department at sswearingen@ohnurses.org or 614-323-1164.

To view ONA’s Position Statement on Medical Marijuana, click here.

STUDY

Introduction
Ohio became the 25th state to legalize medical marijuana when Governor John Kasich signed House Bill 523 on June 8, 2016. The new law became effective on Tuesday, September 6, 2016. Over a two-year span from 2016 to 2018 Ohio developed their rules, regulations and laws. The program was to have product on the shelves by September 8,2018, but per the Department of Commerce this date was not realized. The Dept. of Commerce said product will be available late 2018 early 2019.i The Ohio Medical Marijuana Control Program (OHMMCP) was set up to have 3 state agencies design the rules, regulations and laws for the program as a whole.
• The Ohio State Pharmacy Board was tasked with putting the requirements together for the dispensaries.
• The Ohio State Department of Commerce was tasked with putting the requirements together for the Cultivators.
• The Ohio State Medical Board was tasked with putting the requirements together for the physicians.

Time and again nurse’s rank #1 as the most trusted profession in Gallup’s annual survey of professions for their honesty and ethical standards. Nurses are the “bedside” healthcare providers who strive to promote health, prevent illness and alleviate suffering. The fundamental principles of nursing are compassion and respect for the individual patient. A key role of the nurse is to act as a patient advocate. (ii) Extra Step Assurance (ESA) understands the role that nurses provide. ESA and the ONA want to make sure that this new medicine coming to Ohio is understood and utilized in the most effective manner with our nurses being the expert a patient turns to for information.

As of November 16, 2018:
• 56 dispensaries of the 60 allowed by the state have been awarded provisional licenses
• 26 cultivators of the 24 allowed by the state have been awarded provisional licenses
• 14 processors of the 40 allowed by the state have been awarded provisional licenses
• 5 testing centers have been awarded provisional licenses
• About 330 to 350 physicians are certified to recommend (list will continue to grow)
• Patient registry set to open in 4th Quarter of 2018 or 1st Quarter of 2019

Only physicians (MD or DO) are authorized to recommend medical marijuana, and they must have a special Endorsement/Certification (CTR) from the Medical Board to do so. Nurses are the front line for patients and family members on this new drug. It is critical for nurses to become knowledgeable about uses, dosing, effects, complications, as well as limitations imposed by the patients’ health and by Ohio law. Patients are already asking questions in hopes of having answers from their Health Care Providers in preparation of marijuana becoming available.

 

Rules, Regulations and Laws

Summary of House Bill 523:

Ohio’s Medical Marijuana Control Program (OHMMCP) required that the Ohio Department of Commerce, State Board of Pharmacy and the State Medical Board administer a medical marijuana program.

Some details of the bill:
• Establishment of a medical marijuana advisory committee to make recommendations concerning the OHMMCP to the agencies listed above.
• Permits a patient, on the recommendation of a physician (MD or DO) to use medical marijuana to treat a qualifying medical condition.
• Authorizes the Board of Pharmacy to register patients, their caregivers and the licenses to retail dispensaries.
• Authorizes the Department of Commerce to issue licenses to medical marijuana cultivation, processing, and testing laboratories.
• Authorizes the Medical Board to issue certificates to recommend (CTR) to Physicians (MD or DO) to treat patients with medical marijuana.
• Prohibits the cultivation of medical marijuana for personal, family, or household use.

Ohio vs Federal law (I, ii, iii)
The federal government does not recognize marijuana as an approved medicine. Therefore, physicians cannot legally prescribe it as a medicine. Ohio, as with other states, have legalized medical marijuana despite the federal stand. Due to the federal stand, patients must have a recommendation from a certified physician vs. a traditional prescription that is taken to a pharmacy.

To be certified to recommend (CTR):
• Physician must register/apply to the Ohio State Medical Board
• Hold an active, unrestricted MD or DO license from the Ohio State Medical Board
• Complete at least two hours of OSMA approved continuing medical education yearly that will assist in diagnosing qualifying conditions, treating those conditions with medical marijuana and possible drug interactions.

Qualifying Medical Conditions
ORC 3796.01 (iv)

The information shared in this article is a summary of Ohio House Bill 523. Extra Step Assurance assumes no responsibility for errors or omissions from the content of the original House Bill 523. This should not be used as a substitute for consultation with a legal professional or other competent advisor. Contact a licensed attorney to obtain advice with respect to any legal issues discussed in this documentation or regarding a situation specific to your business or medical practice. Please reference all footnotes for additional information.

Approved qualifying medical conditions: AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.

Forms and Methods of Medical Marijuana ORC 3796.04, 3796.06, 3796.061 (v)
The following forms of medical marijuana methods include oils, tinctures, plant material, edibles, and patches. The bill prohibits forms that are attractive to children. The board of Pharmacy can approve additional forms of medical marijuana. Smoking or combustion of medical marijuana is prohibited, but it does allow inhalation by vaporization.

Tetrahydrocannabinol (THC) Content ORC 3796.06 (vi)
The plant material cannot have more than 35% Tetrahydrocannabinol (THC) content. While extracts cannot have more than 70%.

Patient and Caregiver Registration ORC 3796.08 (vii)
A physician holding a Certificate to Recommend (CTR) issued by the Medical Board submits the patient and caregiver information to the Board of Pharmacy. The recommendation of the patient utilizing medical marijuana will be good for one year. Renewals will be then issued one year following the initial recommendation.

Patient Identifying Information ORC 3796.08 (viii)
The Board of Pharmacy prohibits any identifying information being made public about registered patients or caregivers except in statistical or aggregate form. Only the licensed retail dispensary may have identifying information for a patient to confirm valid registration.

Use, Possession or Administer Medical Marijuana ORC 3796.22 and 3796.23 (ix)
Registered patients may use or possess medical marijuana or possess any paraphernalia or accessories specified in the Board of Pharmacy rules. A caregiver may possess or assist a registered patient in the use or administration of medical marijuana or possess any paraphernalia or accessories specified in the Board of Pharmacy rules.

Possession Limits ORC 3796.22 and 3796.23 (x)
The amount of medical marijuana possessed by a registered patient or caregiver must not exceed a 90-day supply. When a registered caregiver provides care to more than one registered patient, the caregiver must maintain separate inventories of medical marijuana for each patient.

Arrest and Criminal Prosecution ORC 3796.22 and 3796.23 (xi)
A registered patient or caregiver is not subject to arrest or criminal prosecution for any of the following actions done in accordance with the bill’s provisions:
• Registered patient using medical marijuana
• Obtaining or possessing medical marijuana • Possessing specified paraphernalia or accessories
• Registered caregiver, assisting a registered patient in the use or administration of medical marijuana.

Operating a Vehicle ORC 3796.22, 3796.24 (xii)
A registered patient is not authorized to operate a vehicle, streetcar, trackless trolley, watercraft, or aircraft while under the influence of medical marijuana. A person’s status as a registered patient or caregiver is not a sufficient basis for conducting a field sobriety test on the person or for suspending the person’s driver’s license. The bill specifies that to conduct a field sobriety test, a law enforcement officer must have an independent, factual basis giving reasonable suspicion that the person is operating a vehicle under the influence of marijuana or with a prohibited concentration of marijuana in the person’s whole blood, blood serum, plasma, breath, or urine.

Prohibition on Caregiver Use ORC 3796.24 (xiii)
A registered caregiver is prohibited from using medical marijuana, unless the caregiver is also a registered patient.

Parental Rights and Responsibilities ORC 3796.24 (xiv)
Unless there is clear and convincing evidence that a child is unsafe, the use, possession, or administration of medical marijuana by a registered patient in accordance with the bill’s provisions cannot be the sole or primary basis for any of the following:
(1) An adjudication determining that a child is an abused, neglected, or dependent child;
(2) An allocation of parental rights and responsibilities;
(3) A parenting time order.

Tenant Protection ORC 3796.24 (xv)
A person’s status as a registered patient or caregiver is not to be used as the sole or primary basis for rejecting the person as a tenant, unless the rejection is required by federal law.

Assistance for Veteran or Indigent Patients ORC 3796.04 (xvi)
It is required that the Board of Pharmacy establish a program to assist patients who are veterans or indigent in obtaining medical marijuana.

Physician Certificate to Recommend ORC 4731.30 and 4731.301 (xvii)
A physician seeking to recommend treatment with medical marijuana must apply to the State Medical Board for a certificate to recommend. An application must be submitted in a manner established in rules adopted by the Medical Board. The Medical Board must issue a certificate to recommend if both of the following conditions are met:
• The application is complete and meets the requirements established in rules
• The applicant demonstrates that he or she does not have an ownership or investment interest in, or a compensation arrangement with, a licensed cultivator, processor, laboratory, or retail dispensary or an applicant for licensure.

Physician Discipline ORC 4731.22 and 4731.229 (xviii)
In the event a physician fails to comply with the bill’s requirements, the bill authorizes the Medical Board to take the same disciplinary actions against the physician’s certificate to recommend as against a certificate to practice. These include the suspension or revocation of or the refusal to renew the certificate. The bill specifies that any disciplinary action taken against a physician’s certificate to practice operates automatically on the physician’s certificate to recommend. The action taken on the certificate to recommend remains in effect for as long as the disciplinary action remains in effect on the certificate to practice.

Authority to Recommend Medical Marijuana Treatment ORC 4731.30 (xix)
A physician who holds a certificate to recommend may recommend that a patient be treated with medical marijuana if the patient has been diagnosed with a qualifying medical condition (see “Qualifying Medical Conditions” above) and a bona fide physician-patient relationship has been established through all of the following:
• An in-person physical examination of the patient by the physician
• A review of the patient’s medical history by the physician
• An expectation of providing care and receiving care on an ongoing basis
The bill also requires that the physician both request a report of information related to the patient from OARRS that covers at least the 12 months immediately preceding the date of the visit and review the report. In the case of a patient who is a minor, the physician may recommend treatment with medical marijuana only after obtaining the consent of a parent or another person responsible for providing consent to treatment.

Requirements When Recommending Medical Marijuana Treatment ORC 4731.30 (xx)
When issuing a written recommendation to a patient, the physician must specify any information required in rules adopted by the Medical Board. A written recommendation issued in accordance with the bill’s provisions is valid for a period of not more than 90-days. The physician may renew the recommendation for not more than three additional periods of not more than 90-days. Thereafter, the physician may issue another recommendation to the patient only upon a physical examination of the patient.

Physician Immunity ORC 4731.30 (xxi)
The bill provides that a physician is immune from civil liability and is not subject to professional disciplinary action or criminal prosecution for any of the following:
• Advising a patient or caregiver about the risks and benefits of medical marijuana
• Recommending that a patient use medical marijuana
• Monitoring a patient’s treatment with medical marijuana

Physician Reporting Requirements ORC 4731.30 (xxii)
Annually, each qualifying physician must submit to the Medical Board a report that describes the physician’s observations regarding the effectiveness of medical marijuana in treating his or her patients. The report is limited to observations concerning patients treated during the year covered by the report.

Continuing Medical Education ORC 4731.30 (xxiii)
The bill requires that each physician holding a certificate to recommend annually complete at least two hours of continuing medical education in medical marijuana approved by the State Medical Board. The bill further requires that the Medical Board approve one or more continuing medical education courses of study that assist physicians in both of the following:

  • Diagnosing qualifying medical conditions.
  • Treating qualifying medical conditions with medical marijuana. The Medical Board may approve a course or courses of study certified by the Ohio State Medical Association or the Ohio Osteopathic Association.

 

Physician Prohibitions ORC 4731.30 (xxiv)

Furnishing medical marijuana:  The bill prohibits a physician from personally furnishing or otherwise dispensing medical marijuana.

Issuing a recommendation to a family member or the physician’s self:  The bill prohibits a physician from issuing a recommendation for medical marijuana for a family member or the physician’s self.

Licensure of Cultivators, Processors, Retail Dispensaries and Laboratories ORC 3796.09 (xxv) and 3796.10

An entity that seeks a license to cultivate or process medical marijuana or to conduct laboratory testing of medical marijuana must file an application for licensure with the Department of Commerce. An entity that seeks a license to dispense medical marijuana at retail must file an application with the Board of Pharmacy. An application for a cultivator, processor, or laboratory license must be submitted in accordance with rules adopted by the Department of Commerce, while an application for a retail dispensary license must be submitted in accordance with rules adopted by the Board of Pharmacy. Each entity must submit an application for each location from which it seeks to operate.

Conditions on Eligibility for Licensure ORC 3796.09, 3796.10, and 3796.11 (xxvi)

A license will be issued to an applicant if all of the following conditions are met:

  • The applicant demonstrates that it does not have an ownership or investment interest in, or compensation arrangement with, a laboratory licensed by the Department of Commerce or with an applicant for a license to conduct laboratory testing .
  • The applicant demonstrates that it will not be located within 500 feet of a school, church, public library, public playground, or public park.
  • The report of each criminal records check conducted demonstrates that the person subject to the check is not disqualified because of a conviction or guilty plea to an offense specified in rules.
  • The information provided to the Department or Board of Pharmacy by the Ohio Department of Taxation demonstrates that the applicant is in compliance with state tax laws.
  • The applicant meets all other licensure eligibility conditions established in rules.

Criminal Records Check Requirements ORC 3796.12, 3796.13, 4776.01, 4776.02, 4776.03 and 4776.04 (xxvii)

For prospective licensees: As part of the application process, each of the following individuals associated with an entity seeking licensure must complete a criminal records check:  

* An administrator or other person responsible for the daily operation of the entity

* An owner or prospective owner, officer or prospective officer, or board member or prospective board member of the entity. The process for completing a criminal records check provided for in the bill is the same process that applies to certain professionals under existing law.  The Department of Commerce and Board of Pharmacy are required to specify in rule the offenses that disqualify an applicant from licensure (see “Program Rules” above). If an individual subject to the criminal records check requirement fails to complete the check, the Department of Commerce or Board of Pharmacy must deny the entity’s application for licensure.

For employees of licensees the bill requires that each person seeking employment with a licensed cultivator, processor, laboratory, or retail dispensary complete a criminal records check. It also prohibits a license holder from employing a person unless the person complies with the criminal records check requirement and the check demonstrates that the person is not disqualified because of a conviction or guilty plea to an offense specified in rules. 

Authority to Suspend or Revoke a License ORC Chapter 119 (xxviii) 

The bill authorizes the Department of Commerce or Board of Pharmacy to suspend, including without prior hearing, revoke, or refuse to renew a license it issued for any reason specified in rules adopted by the Department or Board. The bill also provides that the Department of Commerce or Board of Pharmacy may refuse to issue a license. An action to suspend or revoke a license must be taken in accordance with the Administrative Procedure Act.

Authority to Inspect ORC 3796.14 (xxix) 

The bill authorizes the Department of Commerce or Board of Pharmacy, as applicable, to inspect the premises of an applicant for licensure and a license holder without prior notice to the applicant or license holder. In the case of the Board of Pharmacy, it may, in addition, inspect all records maintained by a licensed retail dispensary as required by the bill. 

Authority to Place Medical Marijuana under Seal – Retail Dispensaries ORC 3796.15 (xxx) 

The bill authorizes the Board of Pharmacy to place under seal all medical marijuana owned by or in the possession, custody, or control of a licensed retail dispensary if the Board of Pharmacy does all of the following:

  • Suspends, revokes, or refuses to renew the dispensary’s license; 
  • Determines that there is clear and convincing evidence of a danger of immediate and serious harm to any person.  The Board of Pharmacy must not dispose of the medical marijuana placed under seal until the license holder exhausts all appeal rights under the Administrative Procedure Act. The court involved in the appeal may order the Board of Pharmacy, during the pendency of the appeal, to sell medical marijuana that is perishable. The Board of Pharmacy must deposit the sale’s proceeds with the court.

Licensed Cultivators ORC 3796.18 (xxxi)  The bill authorizes the holder of a cultivator license to cultivate medical marijuana and deliver or sell it to one or more processors. 

Prohibition on Cultivation on Public Land ORC 3796.18 (xxxii)  The bill prohibits a cultivator license holder from cultivating medical marijuana on any public land, including a state park.

Licensed Processors ORC 3796.19 (xxxiii)

The holder of a processor license may do any of the following:

  • Obtain medical marijuana from one or more licensed cultivators
  • Process medical marijuana obtained from a cultivator into a form that may be dispensed
  • Deliver or sell processed medical marijuana to one or more licensed retail dispensaries.  When processing medical marijuana, a licensed processor must package it according to federal childresistant effectiveness standards in effect on the bill’s effective date. The processor also must label the packaging with the product’s tetrahydrocannabinol and Cannabidiol content and comply with any packaging or labeling requirements established in rules adopted by the Department of Commerce.

Licensed Retail Dispensaries ORC 3796.20 (xxxiv) 

The holder of a retail dispensary license may obtain medical marijuana from one or more processors and may dispense or sell it to patients. When dispensing medical marijuana, the dispensary must do all of the following:

  • Dispense or sell only upon a showing of a current, valid identification card issued by the Board of Pharmacy and in accordance with a physician recommendation;
  • Report to the drug database maintained by the Board of Pharmacy that medical marijuana was dispensed to a patient (see “OARRS” below);
  • Use only employees who have met the training requirements established in rules adopted by the Board of Pharmacy;
  • Label the package containing medical marijuana with the following information:
  • –  The name and address of the licensed processor and retail dispensary
  • –  The name of the patient and caregiver, if any o The name of the qualifying physician who recommended treatment with medical marijuana
  • –  The directions for use as recommended by the qualifying physician
  • –  The date on which the medical marijuana was dispensed
  • –  The quantity, strength, kind, and form of medical marijuana contained in the package.

Patient Identifying Information – Dispensaries ORC 3796.20 (xxxv)  The bill prohibits a licensed retail dispensary from making public any information it collects that identifies or would tend to identify any specific patient.

Licensed Laboratories  ORC 3796.21(xxxvi)  The holder of a laboratory license may obtain medical marijuana from licensed cultivators, processors, and retail dispensaries and may conduct testing on the marijuana. When testing, a licensed laboratory must test for potency, homogeneity, and contamination and prepare a report of test results.

Forfeiture or Seizure of License Holder Property ORC 3796.24 (xxxvii)  The bill provides that the cultivation, processing, testing, or dispensing of medical marijuana in accordance with the bill’s provisions cannot be used as the sole or primary reason for taking any action under any criminal or civil statute in the forfeiture or seizure of any property or asset.

Other Licensed Professionals  ORC 3796.24 (xxxviii).  Under the bill, the holder of a license, as defined under current law, is not subject to professional disciplinary action solely for engaging in professional or occupational activities related to medical marijuana.

Academic Medical Centers, State Universities, and Private Research and Development Organizations That Engage In Marijuana Research ORC 3796.032 and 3796.24 (xxxix) 

The bill provides that it does not authorize the Department of Commerce or Board of Pharmacy to oversee or limit research conducted at a state university, academic medical center, or private research and development organization that is related to marijuana and is approved by a federal agency, board, center, department, or institute, including any of the following:

  • The Agency for Health Care Research and Quality;
  • The National Institutes of Health;
  • The National Academy of Sciences;
  • The Centers for Medicare and Medicaid Services;
  • The U.S. Department of Defense;
  • The Centers for Disease Control and Prevention;
  • The U.S. Department of Veterans Affairs;
  • The Drug Enforcement Administration;
  • The Food and Drug Administration

 

  • Any board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health care services.
  • The bill also provides that it does not restrict research related to marijuana conducted at a state university, academic medical center, or private research and development organization as part of a research protocol approved by an institutional review board or equivalent entity.

Proximity to School, Church, or Certain Public Places  ORC 3796.30, 3796.09, 3796.10, 3796.03, and 3796.04 (xl) 

The bill prohibits a cultivator, processor, retail dispensary, or laboratory from being located within 500 feet of a school, church, public library, public playground, or public park. The bill requires an entity seeking a license to demonstrate the entity will not be located within 500 feet of a school, church, public library, public playground, or public park. The Department of Commerce must revoke the license of a cultivator, processor, or laboratory that relocates to within 500 feet of a school, church, public library, public playground, or public park. Similarly, the Board of Pharmacy must revoke the license of retail dispensary that relocates to within 500 feet of such places. Finally, the bill requires that the Department and Board specify, in rules adopted under the Administrative Procedure Act, whether a license holder may remain in operation, must relocate, or have its license revoked after a school, church, public library, public playground, or public park opens within 500 feet of the license holder’s premises (see “Program rules” above). For purposes of the bill, a school includes a child day-care center.

Employment Laws  ORC 3796.28 (xli) 

Employment – generally; the bill provides that nothing in the bill concerning medical marijuana does any of the following:

  • Requires an employer to permit or accommodate an employee’s use, possession, or distribution of medical marijuana;
  • Prohibits an employer from refusing to hire, discharging, disciplining, or otherwise taking an adverse employment action against a person with respect to hire, tenure, terms, conditions, or privileges of employment because of that person’s use, possession, or distribution of medical marijuana;
  • Prohibits an employer from establishing and enforcing a drug testing policy, drug-free workplace policy, or zero-tolerance drug policy;
  • Interferes with any federal restrictions on employment, including U.S. Department of Transportation regulations;
  • Permits a person to sue an employer for refusing to hire, discharging, disciplining, discriminating, retaliating, or otherwise taking an adverse employment action against a person with respect to hire, tenure, terms, conditions, or privileges of employment related to medical marijuana;
  • Affects the authority of the Administrator of Workers’ Compensation to grant rebates or discounts on premium rates to employers that participate in a drug-free workplace program established in accordance with rules adopted by the Administrator. 

Under continuing law, the Bureau of Workers’ Compensation’s Drug-Free Safety Program offers eligible employers a premium rebate for implementing a loss prevention strategy addressing workplace use and misuse of alcohol and drugs. In addition to satisfying other requirements, the employer’s program must include alcohol and drug testing, including:

  • Pre-employment and new-hire drug testing;
  • Post-accident alcohol and drug testing;
  • Reasonable suspicion alcohol and drug testing;
  • Return-to-duty and follow-up alcohol and other drug testing.

OARRS ORC 4729.75 and 4729.80 (xlii) The Ohio Automated Rx Reporting System, or OARRS, is the drug database established and maintained by the Board of Pharmacy to monitor the misuse and diversion of controlled substances. Existing law requires that when a controlled substance is dispensed by a pharmacy or personally furnished by a health care professional to an outpatient, this information must be reported to OARRS. Health care professionals and pharmacists also may access patient information in the database.

Reporting to OARRS ORC 4729.75, 4729.771 and 4729.84 (xliii)  The bill authorizes the Board of Pharmacy to monitor medical marijuana through OARRS, by requiring that a retail dispensary or its delegate report to OARRS when dispensing medical marijuana in accordance with the bill’s provisions. Under the bill, a dispensary must report to the database the information specified in rules adopted by the Board of Pharmacy. 

Confidentiality of OARRS Information ORC 4729.80 (xliv)  With respect to information contained in OARRS, the bill provides that it is confidential and may be released in summary, statistical, or aggregate form if it does not identify a person, including any Board licensee or registrant.

The bill also specifies that information contained in OARRS may be provided only as expressly permitted in law, including any information that relates to any person, including any Board licensee or registrant.

Monitoring Database  ORC 3796.07 (xlv)  The Department of Commerce must establish and maintain an electronic database to monitor medical marijuana from its seed source through its cultivation, processing, testing, and dispensing. 

  • The Department may contract with a separate entity to establish and maintain all or any part of the database on its behalf.
  • The database must allow for information regarding medical marijuana to be updated instantaneously. Any licensed cultivator, processor, retail dispensary, or laboratory must submit to the Department any information the Department determines is necessary for maintaining the database.
  • The Department and any entity under contract with the Department is prohibited from making public any information reported to or collected by it that identifies or would tend to identify any specific patient.

Toll-Free Hotline ORC 3796.17 (lvi)  The bill requires that the Board of Pharmacy establish a toll-free telephone line to do all of the following: 

  • Respond to inquiries from patients, caregivers, and health professionals regarding adverse reactions to medical marijuana  Provide information about available services and assistance.
  • Authorizes the Board of Pharmacy to contract with a separate entity to establish and maintain the telephone line.

Nursing Disciplinary Actions ORC 4723.28 (xlvii) 

The Board of Nursing, by a vote of a quorum, may impose one or more of the following sanctions: deny, revoke, suspend, or place restrictions on any nursing license or dialysis technician certificate issued by the Board; reprimand or otherwise discipline a holder of a nursing license or dialysis technician certificate; or impose a fine of not more than five hundred dollars per violation. The sanctions may be imposed for any of the following: Self-administering or otherwise taking into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way that is not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance. (Medical Marijuana is still classified as a controlled substance)(xlviii) 

Current View of the United States and Medical Marijuana Laws

  • 33 states and the District of Columbia have legalized medical marijuana.
  • 68% of the country live in a state or territory where medical marijuana is legal.
  • This represents 200 million people living where medical marijuana is legal as of 11/16/18

What Are Other States Doing That Have Already Legalized Medical Marijuana

Patients whose physicians recommend medical marijuana for certain illnesses and chronic conditions are exempt from criminal prosecution in states that have passed medical marijuana laws. A growing number of states (and the District of Columbia) have medical marijuana laws, although federal law makes no such exceptions from the current drug prohibition policy.

Medical marijuana laws vary drastically in their scope and implementation, including the regulation of dispensaries. Some states only allow terminally ill patients to legally use marijuana, while others are much less restrictive. For general information, including how these laws interact with federal law, see the medical marijuana laws page in FindLaw’s Criminal Law section.

  • Note: More than 15 states (including Texas, Missouri, and Georgia) have legalized CBD oil, a marijuana derivative with negligible amounts of THC (which produces the marijuana “high”). There are a few states that allow recommendations to be given by CNPs and PAs. Ohio is not one of the states; on the list of requirements it states the applicant must be an MD or DO that is in good standing. I have included a few others as examples:
  • New York- Under new regulations, nurse practitioners and physician assistants could begin taking the state mandated certification course and upon completion, approve patients for medical marijuana.
  • Massachusetts- A certifying CNP who wishes to issue a written certification for a qualifying patient shall have at least one established place of practice in Massachusetts and shall hold: (1) An active full license, with no prescribing restriction, to practice nursing in Massachusetts; (2) A Board authorization by the Massachusetts Board of Registration in Nursing to practice as a CNP; and (3) A Massachusetts Controlled Substances Registration from the Department.
  •  Washington- The following types of healthcare practitioners licensed in Washington State are allowed to authorize the use of marijuana to medical patients: Medical doctor (MD), physician assistant (PA), Osteopathic physician (DO), Osteopathic physician assistant (DOA), Naturopathic physician and Advanced registered nurse practitioners (ARNP).

How to Start Talking With Your Health Care Provider

If the patient has questions about whether medical cannabis (marijuana) is a treatment option for them, it is important that you as a health care provider talk with the patient. Below are items that are suggestions that the patient looks at:

  • Review this list of approved conditions for the state of Ohio.
  • Bring all relevant medical records to your professional healthcare provider.
  • Bring a list of all medications you currently use.
  • Bring scientific peer-reviewed articles or references to help educate your healthcare provider. Recognize that many providers have little to no training in the therapeutic use of cannabis, so be patient with them.
  • Prepare a list of the questions you have about medical marijuana. Questions as a health care provider that you could receive from a patient:
  • How do I know if medical cannabis (marijuana) might help me?
  • How do the risks of using medical cannabis (marijuana) compare with other accepted treatment options for my condition?
  • Do you think it’s possible that cannabis (marijuana) could help me with my symptoms or condition?
  • What side effects should I know about if I use medical cannabis (marijuana)?
  • How do you take or use cannabis (marijuana)?
  • How will cannabis (marijuana) interact with other medications I use? – Do I give up other medications? – Will I be high all the time if I use cannabis (marijuana) as medicine?  – Will my health insurance pay for cannabis (marijuana) as with other medications? – If I were to use medical cannabis (marijuana) would you keep track of my experience for a clinical reasons?  

The Importance of Healthcare Provider Education “Cannabis is becoming increasingly understood that it is a very interesting and versatile medicine with much less toxicity than some of the pharmaceutical products it replaces.”(Dr. Lester Grinspoon, Associate Professor Emeritus of Psychiatry at Harvard Medical School, former senior psychiatrist at the Massachusetts Mental Health Center in Boston)

Physician education is likely the most important aspect of any given medical cannabis program and education has improved slightly over the last few years. Looking at the education healthcare providers get from their traditional schooling, 157 accredited medical schools in the United States that were surveyed, only 21, or 13%, “teach the endocannabinoid [system] science to future doctors.” 

In order to understand how to utilize cannabis for practical application, a health care provider must first understand the endocannabinoid system or ECS. The ECS is a scientifically confirmed system in the human brain and peripheral nervous systems that has important homeostasis regulatory functions.  Understanding its components is vital to understanding its function and ability to manipulate it with various plant cannabinoids and Phytocannabinoids in order to treat specific debilitating conditions. 

The human body produces endocannabinoids, “over 113 cannabinoids had been isolated from the cannabis plant.” Research has shown that various cannabinoids can alleviate and reduce the symptoms of specific medical conditions including, but not limited to; chronic pain, cancer, anorexia and weight loss associated with HIV, irritable bowel syndrome, epilepsy, spasticity, amyotrophic lateral sclerosis (ALS), Parkinson’s disease, glaucoma and posttraumatic stress disorder (PTSD). Each legal medical cannabis state has its own specific list of qualifying conditions. For instance, Illinois has an incredible 40 very specific, qualifying conditions such as; Arnold-Chiari malformation, interstitial cystitis, Lupus, Neurofibromatosis and Sjogren’s syndrome. While other states have more generalized lists; Ohio has 21lv qualifying conditions, Maryland has 10lvi while Pennsylvania has 21lvii “serious medical conditions.” All three of the aforementioned states include chronic or intractable pain, seizures and PTSD, among other more broad disorders. But how does health care provider education affect the success or failure of medical cannabis programs?

As with qualifying conditions, legal medical cannabis states also differ with educational requirements for health care providers that are able to recommend cannabis and with those differences come variable degrees of program success, or failure. For instance, New Jersey has no training requirements for health care providers who recommend cannabis to patients.  As of March 2018, the state had upwards of 28,000 registered physicians. Since the program’s inception in 2010, a staggeringly low 536 of those [28,000] physicians were listed on the medical marijuana registry. That’s 536 physicians to 18,574 medical cannabis patients. Aside from the stringent rules of the state and mandatory registration with the Department of Health, physicians simply do not have enough training when treating their patients with cannabis for such things as; appropriate dosing, suitable methods of use and drug interactions. A Maine physician, (Jean Antonucci, 2016) stated that even though she tried to keep up with the science, “it’s very difficult to support patients but not know what you’re saying.” The state of Florida, which does require a minimum of two-hours of physician education, already has 1,269 physicians listed to certify over 70,000 patients for medical cannabis as of March 2018, and though the Florida law passed in 2016, the program has only been operational since mid-2017. 

Yes, health care provider training is of the utmost importance when developing a successful therapeutic cannabis program, but equally important is patient education.  Potential patients need information to make informed decisions regarding cannabis; is this treatment right for them? What forms are best suited to their specific conditions? What strains will be more effective? What are the risks involved with this treatment? Patients need access to factual, up-to-date information from a legitimate source, beginning with their health care provider. Patients should be prepared to discuss the possibility of the treatment with their provider. 

While there is still much to be learned from cannabis as a medical treatment, there are countless testimonies from patients across the country. Perhaps the most well-known story is that of Charlotte Figi; the toddler who was diagnosed with Dravet Syndrome, or myoclonic epilepsy of infancy (SMEI) who, around age 5, suffered from nearly 300 seizures a week during the peak of her illness. The Stanley brothers of the Realm of Caring Foundation, a nonprofit organization, “developed a crossbreed between industrial hemp and a strain of marijuana high in CBD and low in THC. This form of cannabis is now called ‘Charlotte’s Web,’ named after Charlotte Figilx herself.” Another noteworthy cannabis oil patient is Shona Bandalxi, “A sufferer of Crohn’s Disease for eight years, Shona was bedridden and could only walk with a cane. Diagnosed as terminally ill… [Shona] began to treat herself with cannabis oil and voila! She is now considered cured and has a normal life.” These are just two instances where medical cannabis provided relief from incapacitating disorders and afforded patients a better quality of life.   

Recap of the Top 25 points in Ohio Medical Marijuana Program

What 3 agencies are responsible for the operation of Ohio’s Medical Marijuana Control Program?

  • Ohio Department of Commerce- They are responsible for overseeing medical marijuana cultivators, processors and testing laboratories.
  • State of Ohio Board of Pharmacy- They are responsible for overseeing medical marijuana retail dispensaries, the registration of medical marijuana patients and caregivers, the approval of new forms, and coordinating the Medical Marijuana Advisory Committee.
  • State of Ohio Medical Board- They are responsible for certifying physicians to recommend, and may add to the list of qualifying conditions for which medical marijuana can be recommended.

What are the Qualifying Medical Conditions in Ohio?

AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy or another seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is either chronic and severe or intractable, Parkinson’s disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.

 What Forms of Medical Marijuana will be available?

The following forms of medical marijuana will be permitted: oils, tinctures, plant material, edibles and patches. The law prohibits the use of medical marijuana by smoking or combustion, but does allows for vaporization (vaping). The law prohibits any form that is attractive to children.

Will Medical Marijuana be available to Minors?

Yes. However, a certified physician may recommend treatment with medical marijuana only after obtaining the consent of a parent or another person responsible for providing consent to treatment.

Will medical marijuana be permitted to be grown by patients or caregivers for personal consumption? 

No. The law prohibits the cultivation of medical marijuana for personal, family, or household use.

How much medical marijuana will a registered patient or caregiver be able to possess at one time?

The amount of medical marijuana possessed by a registered patient or caregiver must not exceed a 90-day supply.

In the case of a registered caregiver who provides care to more than one registered patient, the caregiver must maintain separate inventories of medical marijuana for each patient.

How is Ohio defining a 90-day supply?

The State of Ohio Board of Pharmacy is statutorily obligated to establish a 90-day supply of marijuana. Using the best clinical data available and after taking best practices in other states into account, recommendations for a reasonably safe 90-day supply of medical marijuana based on THC content was developed.

Will Ohio recognize medical marijuana Registry Cards from other states?

The law requires that the Board of Pharmacy attempt in good faith to negotiate and enter into reciprocity agreements with other states. If Ohio does enter into a reciprocity agreement with another state, more information will be posted to the OMMCP website.

Are there zoning restrictions on where a licensed retail dispensary may be located?

A retail dispensary is prohibited from being located within 500 feet of a school, church, public library, public playground, or public park. In addition, cities, villages and townships may adopt additional regulations to prohibit or limit the number of retail dispensaries.

Will dispensaries be required to report to the Ohio Automated RX Reporting System (OARRS)?

Yes. A retail dispensary is required to report to OARRS when dispensing medical marijuana. A dispensary must report to the database the information specified in rules adopted by the Board of Pharmacy.

How will patients/caregivers be required to register for the program?

A patient seeking to use medical marijuana or a caregiver seeking to assist a patient in the use of medical marijuana must apply to the Board of Pharmacy for registration. The physician who holds a certificate to recommend (CTR) issued by the Medical Board and is treating the patient must submit the application on the patient’s or caregiver’s behalf in the manner established in rules adopted by the Board.

Will Ohio be testing the medical marijuana that will be made available to patients/caregivers for safety and quality?

Yes, a licensed laboratory must test for potency, homogeneity, and contamination and prepare a report of test results. 

Will physicians be required to undergo any educational classes or training regarding medical marijuana?

House Bill 523 requires that each physician holding a certificate to recommend (CTR) annually complete at least two hours of continuing medical education in medical marijuana approved by the State Medical Board.

Is there a website that allows people to stay updated on Ohio’s progress?

Yes, Ohio has a website that allows anyone to access information on the program and HB523; www.medicalmarijuana.ohio.gov

Can additional medical conditions be added to the list of qualifying conditions?

Yes. The law authorizes an individual to petition the Medical Board to add a disease or condition to the list of qualifying medical conditions. 

Will the patient registration status be made publicly available? 

No. The law prohibits the Board of Pharmacy, as well as licensed dispensaries, from making personal identifying information public. Physicians and those employed by dispensaries will be able to verify a patient or caregiver’s registration.

Do I have to be a resident of the state of Ohio to participate in the medical marijuana program?

Patients must be a resident in the state of Ohio with proof of residency. If you do not have an Ohio I.D., an out of state I.D., passport, or other photo I.D.

Will compliance inspections be conducted in dispensaries?

Yes, the Board of Pharmacy may inspect all of the following without prior notice to the applicant or license holder: The premises of an applicant for licensure;  The premises of and all records maintained by a holder of a current, valid license.

Can a patient be both a qualifying patient AND a caregiver?

Yes, the bill prohibits a registered caregiver from using medical marijuana, unless the caregiver is also a registered patient.

What is the contact information for the Ohio medical marijuana program?

77 S High Street, 17th Floor Columbus, OH 43215-6126 Telephone: (614) 466-4143 Fax: (614) 752-4836 TTY/TDD Ohio Relay Service: 1 (800) 750-0750 Toll-Free patient, caregiver and physician line: 1-833-4OH-MMCP (1-833-464-6627)

What are the proposed fees for patients/caregivers?

The annual registration fee for a patient will be $50 and $25 for caregivers. Patients who are veterans or who are indigent and those patients and caregivers will receive a 50% reduction in their registration fee.

How many dispensary licenses can the state of Ohio initially issue?

The State Board of Pharmacy may issue up to sixty dispensary provisional licenses.

Once a physician recommends a patient be treated with medical marijuana, what must be documented?

Treatment plan. Review of 12-month OARRS report. Discussion with the patient regarding any indicators of possible abuse or diversion of controlled substances reflected in the OARRS report. Explanation of risks and benefits of treatment with medical marijuana and the physician’s opinion that the benefits of medical marijuana outweigh the risks. Consent from patient/caregiver, and name of caregiver if applicable.

Does a healthcare provider have to file any reports with the Medical Board?

The physician shall submit to the Board an annual report describing the physician’s observations regarding the effectiveness of medical marijuana in treating patients. The report shall not contain patient identifying information. 

What are the qualifications for a physician to recommend medical marijuana?

  • Active, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery.
  • OARRS registration.
  • DEA registration.
  • No prior action from the DEA or state licensing board based on inappropriate prescribing.
  • 2 hours of continuing medical education that assist physicians in both:  – Diagnosing qualifying medical conditions; – Treating qualifying medical conditions with medical marijuana.
  • No ownership or investment interest in or compensation agreement with any licensed medical marijuana entity or applicant.  

Conclusion

Medical cannabis laws are constantly changing from state to state. What remains the same, however, are the people; doctors, nurses, patients, caregivers, family that are affected by illnesses and debilitating medical conditions that interfere with living a normal life. Valid information and researched verified education are vital components for any medical cannabis program. 

Ohio’s Medical Marijuana Program has set up some of the best resources in the country. The only website one should use when seeking information on the Ohio Medical Marijuana Program is www.medicalmarijuana.ohio.gov

Additionally, Ohio is the one of the few states that required a toll-free number to obtain validated information and report adverse events. The contract was awarded in February of 2018 to Direct Success Inc. and Extra Step Assurance, LLC. The Ohio Medical Marijuana Control Program Toll-Free Helpline responds to inquiries from patients, caregivers, and health professionals. Please dial: 1-833-4OH-MMCP (1-833-464-6627).

About
Parker Lawrence is the President of Extra Step Assurance LLC (ESA) established in 2016 and based in Bellefontaine, Ohio. ESA is the leading expert in medical cannabis education, training and compliance nationwide. ESA believes that our most important role in this industry is to provide expert support, knowledge and guidance to the many professionals leading the charge!
For more information about Extra Step Assurance LLC and our services please call, 855-844-4368 or email info@esacertified.com .

Citations

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Medical Marijuana in Ohio

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